HomeMy WebLinkAboutPermit Renewals PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
BUILDING AND CODE REGULATIONS DIVISION
2300 VIRGINIA AVE
FORT PIERCE,FL 34982
(772)462-1553 Fax(772)462-1578
PERMIT RENEWAL REQUEST
PERMIT NUMBER: OCI I ADDRESS.-39C J::�f�1..1 h,0JV-Af--C1 PY-01-1
:bem'l'�> z2cp-,r,. am requesting that the above permit be renewed. I
understand that I must schedule and pass all required inspections for the permit to be finaled. Further, I
understand that this is a ONE TIME RENEWAL and the permit shall expire should I not receive a
passing inspection during any six month period during the renewal period.
Justification
MNEWBLIV OR CONTRACTOR SIGNATURE DATE
LMA15 zaceK
Print Name
STATE OF FLORIDA.,
COUNTY OF 54. LULI
nd 10
ACKNOWLEDGED BEFORE ME THIS JAY OF 20_10
WHO IS PERSONALLY KNOWN TO ME OR
HAS PROVIDED AS IDENTIFICATION.
S OF ,Aotf_��G�-t U' aF
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4
COLEEN SU
LLIVAN
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%NA R JEO FLORID
R Y COMMISSION#GG071535
GNATURE OF
EXPIRES February og,2029
FOR OFFICE USE ONLY:
Number of Open Inspections:
Total Inspections:
(Divide open by total to get%of open inspections)
Percentage:
Original permit fee: x%open Renewal fee
Example: [15 divided by 23=.65(%)] S175(permit fee)x.65=$113.75(renewal fee)
Revised 7121/2014